Effectiveness of Self-Management Program on Recovery from Total Knee Arthroplasty Surgery in Patients with Osteoarthritis

Background: Osteoarthritis (OA) of the knee is a major cause of mobility impairment. The prevalence of OA is expected to increase dramatically with aging, contributing to a growing demand for total knee arthroplasty (TKA) surgery. According to statistics results, there are more patients have earlier hospital discharge after TKA. It indicates that patients are returning home during a more acute phase of recovery, thus there is a demand of home care interventions for patients still recovering from the TKA surgery. The effectiveness of Self-management (SM) programs are evident in many countries for people to deal with chronic conditions. It is hypothesized that an intensity SM program at this time will has clinical benefits for patients undergoing TKA surgery. Aim:Aim:Aim:Aim: The purpose of the propos The purpose of the propos The purpose of the propos The purpose of the propos The purpose of the proposThe purpose of the propos The purpose of the propos al is to is to implement implement implement a SM program, based on selfa SM program, based on self a SM program, based on self a SM program, based on selfa SM program, based on selfa SM program, based on self a SM program, based on self a SM program, based on self a SM program, based on self -efficacy modelefficacy modelefficacy model efficacy modelefficacy modelefficacy modelefficacy model , forfor patient patient patientpatient after TKafter TK after TKafter TKafter TK A, and , and to to examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of examine the effectiveness of the SM program program program over a 12 months follow over a 12 months follow over a 12 months follow over a 12 months follow -up. Methods: This quantitative research will be divided into two phases in three years. The Phase I will develop SM intervention and carry out the pilot study. Then, the psychometric testing of the instruments will be also completed before the pilot study. In the Phase II, an experimental design will be used to examine the effectiveness of a SM intervention. In this randomized controlled trial of 12 months duration, total 272 patients undergoing TKA will be recruited while the participant at the orthopedic wards of a hospital. The experimental group (N=136) will receive SM intervention added to the clinical routine care, and the control group (N=136) will receive with the clinical routine care only. The SM intervention is developed based on Bundura’s self-efficacy theory, which provides four sources of information for SM: mastery experience, social modeling, social persuasion, and physical and emotional states. The strategies of the SM consist of appraisal, goal setting and self-monitoring of TKA-specific physical rehabilitation and symptom management. The “symptom management” strategy in this study will be focused on infection and pain reduction management. In order to examine the effects of SM intervention, data will be collected with 5 time points by seven health-related outcomes. The main outcome variables will be knee function measurement and knee range of motion. Secondary outcomes will be self-reported quality of life measured by Short-Form-36 Health Survey questionnaire, Knee Injury and Osteoarthritis Outcome Score, Arthritis Self-efficacy Scale, Taiwanese Depression Questionnaire, Self-management behaviors scale and the use of health services. Assessments will be conducted at baseline (pre-discharge hospital) and at 2, 3, 6 and 12 months following hospital discharge. Demographic and medical information will also be collected. Outcome measures of this study will be analyzed using descriptive and inferential statistics with the generalized estimating equations (GEE) analysis. The findings of this study would generate an effective SM model for health professional to facilitate TKA patients the development of self-care capability and improvement of health-related outcomes.

Project ID:PC10301-0130
External Project ID:NSC102-2628-B182-019-MY3